Medical Continuing Disability Reviews

Medical Continuing Disability Reviews

In Benefits and Employment Articles, Benefits Application Articles, Blog, Featured, Ticket to Work Articles by Amber Kwiatkowski

If you receive disability benefits, Social Security is required by law to conduct reviews of your medical situation at scheduled intervals. This process is called a “continuing disability review” (CDR) and is intended to determine if you are medically improved and still entitled to benefits.

If, during a CDR, Social Security finds that your medical condition has significantly improved, your Social Security benefits may end. In general though, most adults who undergo CDRs have their benefits continue.

This article explores some common questions about Social Security medical CDRs.

When Are Reviews Scheduled?

In general, reviews happen every three or seven years. The frequency of reviews is determined by the severity of the disability and the likelihood that improvement will occur.

Reviews are scheduled based on the following three categories:

  1. Medical Improvement Expected – Recovery is anticipated. Review will occur in not less than six months or more than 18 months.
  2. Medical Improvement Possible – Improvement not expected but condition is not considered as severe as a permanent impairment. Review will occur every three years.
  3. Medical Improvement Not Expected – Disability is considered permanent. Reviews will occur every five to seven years.

After an initial disability determination, you will be put into one of the above categories. It is important to understand when your case is likely to be reviewed and be prepared in case of review. Due to funding limitations, many medical reviews have not been completed as scheduled. As a result, there are a large number of beneficiaries that are overdue for medical reviews.

How Do I Prepare for a Review?

First of all, it’s a good idea even before a review to do the following:

  • Pen and read your mail from Social Security
  • Keep copies of documents you send to and receive from Social Security
  • Document your medical tests and treatments
  • Communicate with your doctor about your medical condition
  • Let Social Security know if your address changes

What Should I Do If I Get a CDR Notice?

Social Security will send you a notice to inform you that a medical review is being started. You are able to submit medical and employment evidence to be considered as part of the review.

Social Security in most cases will ask you to complete the SSA-454-BK, Continuing Disability Review Report. This report will ask you for medical information for the previous twelve-month period including medical conditions, treatment received, and medications. There are also questions regarding Education and Training, Vocational Rehabilitation and Employment, and Daily Activities.

If you have a permanent disability, you may be sent a Continuing Disability Report Short Form, which is a short version of the SSA-454-BK. This form is sent from the Social Security central office in Baltimore.

How Does the Review Process Work?

Once the SSA-454-BK is completed and returned, the file is sent to the Disability Determination Bureau (DDB) for review. The DDB uses an Eight-Step Sequential Evaluation process.

Step 1 – Are you engaging in substantial gainful activity (SGA)?

  • a. If yes, eligibility terminates, with the exception of the circumstances below.
  • b. Exceptions:
    • Supplemental Security Income (SSI) Recipients because of Section 1619(a) protections;
    • Social Security Disability Insurance (SSDI) recipients during their Trial Work Period and Extended Period of Eligibility (EPE).

Step 2 – Does your impairment(s) meet or equal a listed impairment?

  • If yes, eligibility continues.
  • If no, go to step 3.

Step 3 – Has there been medical improvement in your impairment(s)?

  • If yes, go to step 4.
  • If no, go to step 5.

Step 4 – Is the medical improvement related to your ability to work?

  • If yes, go to step 6.
  • If no, go to step 5.

Step 5 – Exceptions (POMS 28020)

Even if there is no medical improvement, benefits may cease if any of the first or second group of exceptions apply.

First Group of Exceptions:

  • Have you benefited from advances in medical or vocational therapy or technology related to the ability to work?
  • Have you undergone vocational therapy related to the ability to work?
  • Do new or improved diagnostic evaluative techniques indicate that your impairment is not as disabling as it was considered at the time of the earlier decision?

Second Group of Exceptions:

  • Was a prior determination or decision fraudulently obtained?
  • Did you fail to cooperate with Social Security?
  • Is Social Security unable to locate you?
  • Did you fail to follow prescribed treatment?

If no exceptions apply, your eligibility continues.

Step 6 – Do you have a severe impairment?

  • If yes, go to step 7.
  • If not, eligibility terminates.

Step 7 – Can you perform past work?

  • If yes, eligibility terminates.
  • If no, go to step 8.

Step 8 – Are you able to perform other work in the national economy?

  • If yes, eligibility terminates.
  • If no, eligibility continues.

A Visual Representation / Chart of the Evaluation Process.

What Should I Do if My Benefits Are Terminated?

You can appeal a medical review termination decision and ask for benefits continuation during the appeal.

  • A request to appeal must be made within 60 days from the date the termination notice is received.
  • A request to have benefits continue during the appeal must be made within 10 days.

You are entitled to have an in-person hearing at the Reconsideration Stage. A DDB Hearing Officer makes the final reconsideration decision. The appeals process could continue on to a Hearing by an administrative law judge, review by the Appeals Council, and Federal Court review.

Additional Resources

A Guide to Continuing Disability Reviews for SSDI/SSI Claims provided by Legal Services of New Jersey (LSNJ) is a free website that provides information and assistance regarding self-advocacy and medical reviews.

About the Author

Amber Kwiatkowski

As a Work Incentive Benefits Specialist, Amber provides benefit related services to beneficiaries regarding Social Security Administration work incentives. This includes public benefits, health care systems, as well as other financial issues concerning benefits received. Amber also provides ongoing training and community outreach for individuals and professionals on a variety of benefits-related information and community resources. More about Amber